Jacksonian Miscellanies, #47

February 3, 1998

Pages from a Doctor's Manual

Copyright by the editor, Hal Morris, Secaucus, NJ 1997. Permission is granted to copy, but not for sale, nor in multiple copies, except by permission.

Jacksonian Miscellanies is a weekly* email newsletter presenting short** documents from the United States' Jacksonian Era, which you can receive it for free by sending to hal@panix.com a message with

as either the subject line, or as the *only* line in the message body. If you want to make a comment or query, please send a separate message to hal@panix.com.

Jacksonian Miscellanies can also be read at http://www.panix.com/~hal/jmisc. The WWW version is augmented with much biographical, bibliographical, and other information.

Please direct responses and comments to hal@panix.com,

Pages from a Doctor's Manual

The following comes from Thomas John Graham, Modern Domestic Medicine, To Which is Added, a Domestic Materia Medica (London, 1827). I include a section of the ague, the chronic complaint of western pioneers especially, and sections from the Materia Medica, to supplement it with some descriptions of the medicines used to cure or alleviate the ague. "The best" is "bark", or "Peruvian bark", or better yet, its distillation, "sulphate of quinine".

The description of iodine (having nothing to do with the ague, but I found it interesting), indicates that it had been noticed that it can be "used with striking advantage in relieving the acute pain attendant upon hard and malignant swellings". Today we would say that the swellings on which it works are caused by bacterial infections, which the iodine suppresses. To the early 19th century doctor, though, the fact that it worked on some hard and painful swellings and not on others was a mystery.

It is also noted that iron has positive effect on the blood -- that it "increases the vigour of the circulation, causes the blood to assume a more florid hue". Doctors paid a lot of attention to bodily fluids in those days -- part their small trove of knowledge was the observation of different bodily fluids and circulated by different means, or residing in particular parts of the body. Blood was the most accessible, and perhaps their fascination with removing "excess blood" comes from the phenomenon "To the man with only a hammer, the whole world looks like a nail" (Santayana said it, I think).




D I S E A S E S .



AGUE, or intermittent fever, is a fever consisting of paroxysms, or periods of fever, between each of which there is a distinct and perfect intermission from febrile symptoms. There are several kinds, or species of ague, but the quotidian, which returns every day; the Tertian, which returns every other day; and the quartan, occurring on the first and fourth day, are the principal. It is likewise termed autumnal ague, when it happens in autumn, and vernal, when in the spring.

SYMPTOMS.-Every fit of ague consists of three stages:- a cold, a hot, and a sweating stage. In the cold stage, the face and limbs become pale, the features shrink, the sensibility is greatly impaired, the breathing short and anxious, and a sensation of severe cold is felt over the whole body, succeeded by shivering and violent shaking. Afterwards, the heat of the: body returns, and soon becomes dry, burning, and much above the natural standard; the countenance is now flushed and tumid; there is often acute pain of the head, sometimes slight delirium; the pulse is strong, full, and frequent, and the thirst urgent. These symptoms are followed, first, by moisture of the skin, and then by an universal and equable perspiration, which terminates the fit. The whole paroxysm generally occupies about eight hours.

In the intermission, the countenance is apt to be pale and shrunk and the constitution in general to be affected with or and feebleness. In the commencement of agues, however, the patient is sometimes free from indisposition.

Spring agues are, in general, less severe and obstinate, and less liable to be followed by dangerous consequences, than the autumnal; they are also less liable to return.

CAUSES.-The chief predisposing cause is debility, however induced; but the grand exciting cause is marsh miasma, or the effluvia arising from stagnant water, or marshy ground, impregnated with vegetable matter in a state of putrefactive decomposition. Dampness, and the night air, are particularly favourable to the full operation of marsh miasma. Ague does arise, however, from other causes than marsh effluvia; and it may be produced by sympathy, or irritation in the stomach and intestines.

TREATMENT.-On the commencement of the actual fit, the patient should be placed in bed between the blankets, and partake freely of warm diluting, but not stimulating, drinks, as water­gruel, barley­water, &c.; and thirty or forty drops of laudanum may be given in a little cinnamon water. In some cases, the laudanum is most useful when given directly the cold fit is felt to be approaching; in others, after the commencement of the hot fit. One scruple of the subcarbonate of ammonia, with eight grains of the compound powder of ipecacuan, and an ounce and a half of mint water, form a draught of much service in moderating the attack, when given on the invasion of the cold fit.

In the intermissions, the principal indications of treatment are, to cleanse and strengthen the stomach and bowels, and to invigorate the general habit. The Peruvian bark is well known to be, in general, the most valuable medicine in the cure of ague; but previous to its exhibition, the stomach must be cleansed by the use of an emetic, consisting of twenty grains of ipecacuan powder, and after that has ceased to operate, the bowels should be evacuated by giving one of the pills, No. 87, page 98, washing it down with a full dose of the purging mixture, No. 67, page 93. The sooner the bark is commenced after these operations the better. It is most efficacious in the form of powder, and in large doses, administered at short intervals. An ounce of the best bark may be divided into eight doses, and a dose taken every hour, or every second hour. When the interval between the fits is short, it must be administered immediately after the paroxysm, and continued till the return of the next; on the other hand, when the intermission is long, its exhibition should be delayed till within six Or eight hours of the time at which the cold fit is expected. It must invariably be continued for some days after the attacks disappear.

If great debility prevail, the bark must be combined with wine and aromatics: each dose may be taken in a large wineglassful of old Port, with a scruple of aromatic powder. If it occasion purging, add three or four drops of laudanum to every dose; if costiveness, mix the dose with a scruple or two of powdered rhubarb occasionally. When nausea and oppression attend its use, twenty or thirty drops of the diluted vitriolic acid is an excellent addition to each draught.

In very obstinate agues, the bark will sometimes be more efficacious if mixed with strong brandy and water.

But there is a preparation of Peruvian bark, not long since introduced, called the sulphate of quinine, which is still more valuable than the bark itself, inasmuch as it operates more quickly, with greater certainty, and in a smaller compass, than the latter. It is equal to the removal of the most inveterate cases, and will sometimes cure this disease after the bark in substance has failed. Two, three, or four grains of the sulphate of quinine, made into a pill with a small quantity of extract of gentian, may be taken in the same way as the powdered bark; and after the disease is removed, one of these pills should be continued twice a day, for a week or two, to prevent a relapse. This medicine is particularly useful in the ague of children, as it may be administered to them almost without their tasting it, and when they could not be prevailed upon to swallow the bark in any other form. It is an article which enjoys the confidence of the whole medical profession.

Should the pulse be hard and strong, and other inflammatory symptoms be present, as pain in the side, &c. this state must be reduced before giving the bark, by a low diet, and particularly by taking away eight or ten ounces of blood from the arm; since pounds of bark have been given, under such circumstances' without effect, when the disease has yielded readily after the loss of a little blood.

The two foregoing remedies are, in general, by far the best for intermittents of every kind; where they fail, arsenic or cobweb are the best substitutes. In Lincolnshire, and other Counties where this fever is very prevalent, arsenic is much employed, and with great success; but it is a remedy of so active a nature as to be fit to be taken only under the care of a medical practitioner, and then it ought never to be employed till other and less deleterious medicines have failed. Four drops of the arsenical solution, gradually increased, if necessary, to six or eight drops, twice or thrice a day, will speedily cure the most obstinate agues. It is seldom advisable, or requisite, to continue its use beyond ten days, or a fortnight.-See Arsenic.

Cob­web is an old and popular remedy for the present fever, and it is as efficacious as popular. Some writers speak of it as a mere dirty object of vulgar superstition, but they are much mistaken, for ten grains of cob­web given twice or thrice before the expected time of each paroxysm, and continued in this way, for three or four days, or longer, as circumstances indicate, will be found a powerful mean of putting an immediate and permanent stop to the recurrence of the ague. The patient should, however, be prepared for its use by the previous employment of an emetic and purgative, as prescribed before beginning the bark. The only valuable cob­web is that produced by the black spider, which inhabits cellars, barns, and stables. It is sometimes very effectual in arresting the progress of the febrile symptoms in every other kind of fever. Dr. Jackson, a physician of acknowledged accuracy, and great experience in the treatment of fevers, observes, that it is more abrupt and efficient in its operation than bark or arsenic, or any other remedy employed for the purpose, with which he is acquainted.

When this disease proves unusually obstinate, a somewhat different plan may be pursued. In the case of a quartan, in St. Thomas's Hospital, which had lasted two years, Dr. Fordyce prescribed ten grains of the compound powder of ipecacuan, with a scruple of carbonate of ammonia (which may be taken in any aqueous vehicle), two hours before the paroxysm was expected. It succeeded perfectly. A profuse perspiration followed the use of this draught, and entirely prevented the cold fit; bark was next freely given, and this obstinate ague was cured in a few days.

Fifteen grains of salt of tartar, with a scruple of chamomile flowers in powder, and an ounce and a half of mint water, form a draught that teas often been found of superior advantage in particular cases of ague which had resisted the employment of the bark. It may be given every filth or sixth hour during the intermission.

When an ague is accompanied with a sallowness of the complexion, and pain, tenderness, ­ or swelling about the region of the stomach or liver, indicating the existence of some internal obstruction or disease, the alternative pill, No. 88, page 98, should be taken every night for some time; in order to its removal. In very swampy situations, especially in hot climates, obstructions and disease of the bowels, liver, or spleen, are very apt to arise in protracted intemittents; when the bark will often disagree, and it will be necessary to substitute some other bitter for it, as gentian, quassia, or chamomile. In such cases, the compound powder of ipecacuan will be found very serviceable, as an adjunct to the bitters.

With respect to diet, if, in the commencement, the pulse is hard anti strong, and the lace flushed, these inflammatory symptoms will require a spare mild diet; but debility generally prevails, and then it ought to be as full and generous as the stomach will easily bear, observing to take that food which affords the most nourishment with the least irritation as mutton or lamb chops, chicken, eggs, bread, and good wine.

All agues are very liable to return from the operation of slight causes; the patient will, therefore, find it necessary to avoid exposure to marsh miasma, and all other sources of debility. If he lives in a part of the country where swamps and fens are numerous, he should take a dose of the sulphate of quinine twice a day, for three or tour weeks, occasionally, particularly in the spring and autumn, and carefully avoid exposure to the night air.

BARK (p8)

This heroic medicine, which was formerly called the Peruvian or Jesuits' bark, is now almost always by distinction called the Bark. The Latin name for it is Cinchona, and there are three varieties in common use, viz. the yellow, pale, and red bark. The yellow bark is that which is now most frequently used by medical men in this country.

It is well known, that the tree producing this medicine is a native of South America, whence the bark was first introduced into Europe about the year 1640, by the Countess of Cinchon, who, it is asserted, was cured by it of a severe ague and who was the wife of the Count of Cinchon, Viceroy of Peru. It was sold at first by the Jesuits for its weight in silver, and was consequently very little used; till Talbot, an Englishman, brought it into vogue by the many cures he performed by it in France, under the name of the English Remedy. This remedy was an infusion of the bark in Port wine; and so successful was Talbot's practice, that Louis XIV. was induced to purchase at a large price the secret of his specific; and Charles the Second afterwards appointed him one of his physicians. Long since this period, however, warm controversies have at different times been carried on respecting its virtues, and the most injurious consequences have been attributed to its employment, even by respectable physicians. And it is not a little singular, that, according to Baron Humboldt, the present people of South America have the most inveterate prejudices against the employment of the different kinds of cinchona; and in the very country where this invaluable remedy grows, they try to cut off the fever by infusions of scoparia dulcis, and hot lemonades prepared with sugar and the small wild lime, the rind of which is equally oily and aromatic.

In England, the bark is now universally allowed to be a powerful and permanent tonic, superior to all other remedies in counteracting the diseased actions of intermittent fever, and of eminent utility in restoring strength and vigour to the human frame, when weakened by hectic, remittent, or typhus fever periodical pains. and acute rheumatism. A striking circumstance in respect to its operation is, that those diseases are most benefited by it, the exacerbation, or increase of which returns at stated periods; amongst which we find ague and hectic fever,, and often head­ache and other pains, hysterics, epilepsy, and acute rheumatism. In the low stage of remittent and typhus fevers, particularly when these are attended with symptoms of putridity, as in jail­fever, putrid sore throat, malignant scarlet fever, confluent small­pox, and in putrid measles, the bark must be regarded as one of the most valuable remedies; and the best adjuncts in these cases are the diluted sulphuric, or the muriatic acid, and the tincture of cayenne pepper, It is likewise useful in some cases of gout, and in the termination of all acute diseases, when the patient is certainly recovering. Should it fail in the cure of ague when used alone, it will often perfectly succeed if infused in Port wine, or mixed with strong brandy and water. The compound tincture of bark is also a useful addition to the decoction and powder.

In indigestion, it is rarely of much service, being in that complaint inferior to the purer bitters, as the chamomile, gentian, and columba.

It is given in the form of powder, decoction, infusion, or tincture. The form of powder is that which is in general the most efficacious, but the compound tincture is without doubt an elegant and effectual preparation, being the same as the celebrated tincture of Huxham,, who generally gave it in agues and low nervous fevers, in diluted wine or water, with ten drops of the elixir of vitriol in each dose. The dose of the powder is from ten grains to two drachms. In ague, large doses are required even at the commencement; but in other diseases fifteen grains are sufficient to begin with,, which may be repeated every two, three, or four hours, and gradually increased to a drachm. Its taste is best covered by milk, or a strong solution of liquorice, and the dose should be taken directly after it is mixed. The dose of the decoction and infusion is from one to three ounces, and of the compound tincture from one to three or four tea­spoonfuls.

There is a concentrated preparation of bark lately brought into notice, called sulphate of quinine, which promises to be of much utility, and which I have noticed in alphabetical order.

IODINE (p36, 37)

This is a peculiar substance procured from sponge, and other species of fucus. It is a very active medicine, and in all its forms is used with striking advantage in relieving the acute pain attendant upon hard and malignant swellings, whether of a scrophulous or cancerous nature, and in reducing their size, or preventing their increase. It will often speedily mitigate the most agonizing pain in these complaints, and is applicable to solid tumours of almost every description. It has been highly praised for its virtues in scrophula, but here its use is limited, and its efficacy in curing the disease seldom considerable; for iodine being a remedy of great activity, it cannot under any circumstances be used unremittingly for more than a very short time, and even when employed with regular intervals its continued use is apt to induce much emaciation and debility, and thus to aggravate the scrophulous symptoms, rather than relieve them, as they originate in debility, and are never permanently benefited by any mean which lessens the tone of the general system. In indolent enlargement of the testes in men, accompanied with severe pain, it is a valuable medicine, giving more speedy and effectual relief than any other substance.

Much caution is requisite in its administration. In delicate, nervous habits, it is liable to bring on palpitations, dry cough, tremors, and other disagreeable symptoms.

Internally, it may be given in the form of tincture of iodine, or solution of hydriodate of potash. The dose of the former is from ten to fifteen drops for adults, and of the latter, from six to ten drops. It may be taken in sugar and water, and repeated twice or thrice daily; but neither preparation should he taken constantly, the safest and most effectual mode of administering this medicine being for the patient to take it for eight or nine days, then to lay it aside for the same number of days, and afterwards to resume and discontinue it alternately, at similar intervals. The solution of hydriodate of potash is generally and deservedly preferred.

For external use, from half a drachm to a drachm of the hydriodate of potash, (the salt) is mixed with an ounce and a half of recent hog's lard, and about the size of a nut rubbed into the scrophulous or cancerous tumour, night and morning, for eight or nine days, and then laid aside and resumed in the same manner as I have directed above for the use of the tincture. When this remedy is employed for alleviating the pain and reducing the size of hard and painful swellings, it is scarcely ever necessary for a patient to take it internally, the external use, in the form of ointment, having as much effect as its internal exhibition, with the advantage of greater safety, and direct application to the diseased parts.


This plant comes from Bahia, Rio Janeiro, and other provinces of the Brazils. There are three varieties of the root, the brown, the grey, and the white, of which the first is by far the best.

Ipecacuan, when administered in large doses of ten or fifteen grains, is emetic; in smaller ones of two or three grains, diaphoretic and expectorant; and in still smaller doses it acts as a stomachic, stimulating and giving energy to the digestive organs. As an emetic it is mild, safe, and certain in its operation: it evacuates completely the contents of the stomach, and does not so much weaken it as antimonial emetics. It is the emetic best adapted to children. It is an established fact, that an emetic given at the commencement of continued fevers, will sometimes cut short their progress, or if it fail in accomplishing this object, will give to the subsequent symptoms a milder aspect, and with this view, fifteen or twenty grains of ipecacuan powder may he used with great advantage. In doses of two or three grains repeated every three or four hours, till it operates by vomiting, sweating, or purging, it is found of eminent utility in dysentery and chronic looseness; indeed, its effects in these severe complaints are often invaluable, and it is, perhaps, the most beneficial aperient in dysentery; for when we can bring it to act in this way, it produces a steady determination of the peristaltic motion of the bowels downwards, at the same time that it strengthens their internal surface, and relaxes the skin. Helvetius first made known its use in dysentery, and was rewarded by Louis XIV with 1000 livres, sterling for the discovery. In the same doses it is of excellent use in spitting of blood, hooping­cough, difficulty of breathing, and spasmodic asthma. In spitting of blood, it is particularly worthy of confidence both to stop its progress, and prevent its return.

In still smaller quantities of a grain, or half a grain, three or four times a day, it strengthens the digestive organs, and is very beneficially employed as a remedy for indigestion, bilious, and liver complaints. In such cases, it may either be used alone made into pills with a little hard soap, or be combined with steel, or any bitter extract.

When combined with opium, it forms the compound ipecacuan powder, and proves a valuable anodyne, sudorific, and alternative, of great service in acute and chronic rheumatism, and in other complaints in which we wish to relieve pain, procure sleep, and at the same time relax the skin.


Preparations of iron, or steel as they are sometimes called, are of all metals the most salutary to the animal system, iron being the only metal having any sensible activity which has no poisonous quality. When given medicinally, the effects obtained from it are those of a tonic; it increases the vigour of the circulation, causes the blood to assume a more florid hue, promotes digestion, excites the secretions, or restrains them when they have been morbidly increased from debility, and by its astringency checks profuse evacuations, and counteracts the tendency to haemorrhage. The diseases in which it is used are those which are dependent on, or attended with, a weak, languid habit of body, as green­sickness, indigestion, and its consequences, hysterics, whites, palsy, scrophula, rickets, and the last stage of consumption. It is also beneficial in cancerous ulceration, and other ill­conditioned sores. The use of iron is improper when there is a considerable tendency to inflammatory action, or any particular fulness of the vessels. In these states of the system it occasions heat, thirst, head­ache, laborious breathing, and many other unpleasant symptoms, when its administration ought to be suspended, But when given in a proper state of the body, few medicines are capable of producing more beneficial effects.

Numerous preparations of this metal are medicinally employed, the chief of which are the subcarbonate of iron, the sulphate, and tartarized iron.

The Subcarbonate of Iron is one of the most valuable of its preparations, and that which is in common use. It is tonic,, and is a useful remedy in indigestion, head­ache scrophula, green­sickness, worms, and in all cases in which preparations of iron are indicated. Mr. Carmichael, of Dublin, has also used it as a remedy in cancerous ulceration, both internally administered in large doses, and externally applied sprinkled on the sore. Cases have been given in which this practice has proved successful; and there can be no doubt of its value in such diseases, for it relieves pain, promotes a healthy discharge, and strengthens the general habit. The dose is from five to twenty grains, repeated twice or thrice a day, made into pills with a little mucilage of gum arable, or extract of gentian. A small quantity of aromatic powder causes it to sit easier on th stomach.

The Sulphate of Iron is one of the most active preparations of the metal, and may be advantageously employed in all the complaints above enumerated. The dose is from one to five grains, combined with extract of gentian.

Tartarized Iron possesses the same medicinal powers as the other preparations of iron; but from its mildness, slight taste, and ready solubility, it is a more convenient form for the administration of iron to children, and in many cases in which the other saline preparations of it prove nauseating, and sit uneasy on the stomach. It has been extolled as a remedy in dropsy, in which it is supposed to exert both a diuretic and a tonic power. The dose is from ten grains to half a drachm, given in the form of powder or bolus, combined with four or five grains of aromatic powder. It may be repeated twice or thrice a day.

Purging Mixture No. 67 (p93)

Take of Epsom salt, Glauber's salt, of each half an ounce; spearment water, five ounces, antimonial wine, two drachms; tincture of senna, an ounce. Mix.

Useful on all ordinary occasions as a purging medicine. Two, three, or four table-spoonfuls may be taken for a dose, and repeated, if necessary, every three hours till it operates.

PILLS. (p98, 99)

Pills are masses of a consistence sufficient to preserve a round form, yet not so hard as to be of too difficult solution in the stomach, this form of preparation is particularly adapted for medicines which have a very nauseous taste or flavour, and such as operate in minute doses. Extracts, when not too hard, may be formed into pills without any addition; but more generally pills are composed of either vegetable, or earthy, or metallic powders, combined by means of syrup, mucilage of gum arabic, or some bitter extract, into a coherent mass. Pills should never weigh more than five grains each.

Purgative Pills. No. 87.

Take of compound extract of colocynth, compound rhubarb pill, of each, half a drachm; calomel, twelve grains; oil of carraway, five drops; syrup, a sufficient quantity to form the whole into a mass. Divide it into fifteen pills.

These are excellent purgative pills, of great service in fevers, inflammation, and all cases in which such a purgative is required. They evacuate the intestines through their whole extent, and in doses of two or three at bed­time, are pretty certain of procuring some copious evacuations the next day.

One pill, or even half of one, generally operates as a very mild yet effectual aperient, of much benefit in costiveness, low spirits, and on all ordinary occasions.

Alternative Pills. No: 88.

Take of calomel, twenty grains; emetic tartar, four grains; resin of guaiacum, in powder, two scruples. Rub them well together in a mortar for ten minutes, then with a little conserve of hips make them into a mass, and divide it into twenty pills.

Alternative Pills. No. 89.

Take of calomel, twenty grains; James's powder, twenty­five grains; resin of guaiacum, in powder, two scruples. Rub them well together in a mortar for ten minutes, then with a little conserve of hips form them into a mass, and divide it into twenty pills.

Both these are excellent forms of alternative pills and are of eminent service in almost all chronic diseases. They operate mildly yet effectually in altering the diseased condition of action in the smaller vessels of the circulating system, and thus are employed with superior advantage in numerous severe, obstinate, and apparently dissimilar complaints. They enjoy the confidence of the majority of the most distinguished members of the medical profession in this country, and are daily prescribed by them, as well to correct a derangement of function, as to check the progress of organic injury. They are of great service in bilious and liver complaints, diseased joints, scrophulous and other tumours, chronic disease of the eye, and, indeed, in almost all obstinate and protracted maladies.

One pill is given every night, or every other night, for several weeks in succession. If the disease is of an aggravated character, and it is necessary to employ means to check its progress directly, a pill may be administered night and morning until that object is accomplished, and then the quantity should be reduced to one every night. In very severe diseases, this plan may be persevered in for many weeks or months successively, and with increasing advantage.

You can support this site at no cost if you make an Amazon purchase using this link to get to Amazon: Thanks